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He was always very proud of his army service buy 140mg malegra fxt amex, and after his death he was buried in Arlington ceme- tery in Virginia buy malegra fxt 140mg line. After his return to civilian life, Orr perfected his method and applied it to cases of acute hematogenous osteomyelitis and open Marino ORTOLANI fractures. During the Spanish Civil War, Trueta used 1904–1983 with great success the Orr method, with some modification, in the treatment of open fractures. Very few non-orthopedic surgeons have con- The use of the Orr and Trueta method has been tributed as much to the study of congenital hip eclipsed by the introduction of antibiotics and the pathology as Professor Marino Ortolani. He was emphasis on delayed primary or early secondary born in 1904, studied medicine in Bologna, Italy, closure of wounds, coupled with effective inter- and became a pediatrician, opening his practice in 250 Who’s Who in Orthopedics 1929 in Ferrara, Italy. It is interesting how a single pathology in the newborn and sent his nurses to case completely changed the scientific interest the homes (in Italy not all children are born in the and career of Professor Ortolani. The child’s mother was worried because, on a bicycle to reach the most remote areas of the since birth, she had felt a click every time the per- province of Ferrara. Professor Professor Ortolani became interested in Ortolani became very interested in this fact, anatomical pathology of the congenital hip in asking the mother to reproduce this click. He 1938 and dissected numerous hips in very young carefully examined the baby and found that babies who died from unrelated causes. He col- during abduction–adduction motion of the thigh, lected many excellent specimens of congenital the click was clearly audible and palpable. He hip pathology in the fetuses at all stages of took an x-ray of the hips and congenital hip intrauterine development, proving that congenital pathology was clearly recognized. Profes- Professor Ortolani started examining the hips in sor Ortolani was a pioneer of the very early diag- all newborn children born in his hospital and all nosis and treatment of congenital hip pathology. He started treating these children in abduc- pediatric and orthopedic meetings in Italy and all tion and external rotation of thighs, holding them over Europe, and was an active participant at all loosely with three diapers. The immense love and patience in treating its Importance in the Early Diagnosis of Con- these small children who came to walk normally genital Hip Predislocation. In 1938, Professor Ortolani became director of the Children’s Hospital, but his special interest remained the hips in newborn children and babies. In those years he contributed much to the very early diagnosis and treatment of congenital hip pathology in the province and town of Ferrara, and in 1946 the Italian government opened the “Center for the Diagnosis, Prophylaxis and Treat- ment of Congenital Hip Dislocation,” which was the first of its kind in the world. Professor Ortolani has diagnosed and treated personally over 8,000 children with congenital hip pathology. Since the opening of the Center for the Diagnosis, Prophylaxis and Treatment of Con- genital Hip Dislocation, Professor Ortolani had dedicated all of his professional and scientific activity to the congenital hip problem. His energy, organizational capabilities and his love of teach- ing were endless. He educated his nurses on the examination and treatment of congenital hip 251 Who’s Who in Orthopedics medical school, he served as a student intern at the House of the Good Samaritan. This institution was devoted to the care of patients with chronic diseases and, at that time, was, to a large extent, filled with tubercular patients; among these were many with tuberculous joint disease. Undoubt- edly, it was from assisting such orthopedic sur- geons as Edward Bradford, Elliott Brackett, and Joel E. Goldthwait in the care of these patients that he became interested in orthopedic surgery. Following graduation, he served a surgical intern- ship at the Massachusetts General Hospital. At that time, the first machines for clinical roentgenographic study were introduced, follow- ing Roentgen’s great discovery of x-rays in 1895. We can easily imagine how Robert Osgood, with Robert Bayley OSGOOD the eagerness of youth and with the background of his orthopedic experience at the House of the 1873–1956 Good Samaritan, where the diagnosis of bone and joint conditions was based only on clinical Robert Osgood, or Bob, as he was always known examinations and impressions, would become to his friends, was of good New England stock. He formed a 1873, the son of John Christopher and Martha friendship with Walter J. His line could be traced the Massachusetts General Hospital, who, for back to John Osgood who emigrated from Hamp- lack of a better qualified person, had undertaken shire, England, to Andover, Massachusetts, in to make the first experiments in the use of the x- 1638. Together they explored its value as Following an education in the public schools of a diagnostic aid. After finishing his internship, his Salem, Robert Osgood was admitted to Amherst first hospital appointment was that of roentgenol- College, from which he was graduated in 1895 ogist at the Boston Children’s Hospital in 1902 after the usual classical training in Greek, Latin, and 1903. While in college his chief made the observations on the growth and trau- outside interests were dramatics and singing with matic disturbances of the tibial tubercle during the glee club; these interests he retained through- adolescence, which were published in a paper out his life. These lesions have since independent in politics, a Congregationalist, and become known as Osgood–Schlatter disease, a candidate for medical school.

Polyclinic Hospital in Manhattan and the House Thompson generic malegra fxt 140mg with amex, Bill was exposed to many areas of of St generic malegra fxt 140mg without a prescription. Giles (a children’s orthopedic hospital) orthopedics, with particular emphasis on the spine in Brooklyn, Bill succeeded Dr. Thompson as Director of the Department of residency at the Seaview Hospital in Staten Orthopedic Surgery at St. Luke’s Hospital in Island, a major center for the treatment of tuber- 1973. He became director of a combined ortho- 104 Who’s Who in Orthopedics pedic program with Roosevelt Hospital, which was integrated in 1987 after the two institutions merged. Bill was an energetic, highly motivated surgeon and educator with excellent clinical and operative skills. His enthusiasm for orthopedic surgery was passed on to many of the residents whom he trained, who were often in awe of his accom- plishments and his unique personality. He pro- duced 14 sound-slide programs and 15 medical motion pictures and videotapes and was credited with 162 scientific publications, 60 of which appeared in The Journal of Bone and Joint Surgery. Well known as an international lecturer and teacher, he was invited to serve as a visiting professor at many academic institutions and societies in America and throughout the world. Although his interests encompassed many areas Jean Timothee Emile FOUCHER of the musculoskeletal system, his major contri- butions were related to his work on the cervical 1823–1867 and lumbar spine. Despite his remarkably busy career, Bill found Jean Timothee Emile Foucher was born in Saint- time to study the origins of ancient civilizations. Mars, where his father conducted a small private He visited many sites around the Mediterranean school. It was his father’s wish that his son would and in Central and South America and assembled follow his example and become a teacher also, an outstanding collection of photographic slides and it was over considerable opposition that that were of archaeological and anthropological Foucher broke away to attend medical school in interest. He gradually rose through the ranks pedic meetings and was always ready to given an of the medical system in Paris as a protégé of interesting dissertation on the structural remains Velpeau, becoming chief of the surgical service of ancient cities, tombs, and meeting sites, during at Bicetre in 1863. He which he would point out evidence of muscu- conducted animal experiments using various loskeletal diseases and how they were treated in anesthetic agents, tested a number of antiseptics, early times. His work on epiphyseal injuries falls during a Fielding slide show, and those who were into this last category. In order to appreciate his present at his Presidential Address in Anaheim, accomplishment, his short career must be viewed California, will not forget the multiple slide pro- against the background of the turbulent times in jectors that were positioned and synchronized which he worked. The pres- the result of a ruptured aneurysm of the thoracic entation received a standing ovation. He was survived by his wife, Doris; four children, Pamela, Bruce, Debra, and Victoria. At the time of his retirement from the Chair of Orthopedic Surgery at the Medical College of the University in 1938, he was made Professor Emeritus. During the World War he served as Major in the Medical Corps, United States Army, and was Chief of the Department of Orthopedic Surgery at Walter Reed Hospital at that time. Freiberg always took a special interest in the affairs of the American Orthopedic Associa- tion, particularly in its development, to the end that it might be an important and influential factor in establishing and maintaining a high and digni- fied standard. He was President of the Association for the year 1910–1911 and always took an active part in the scientific and administrative proceed- ings of all its meetings, and served on many important committees. Freiberg was frequently consulted on matters 1868–1940 of parliamentary law. His mind was keen and ana- lytical, his judgment fair and tinged with kindli- Dr. He was a splendid speaker and his tongue August 17, 1868, the son of Joseph and Amalia had no barb. He was a graduate of the University of quently turned the discussion toward correct and Cincinnati and of the Medical College of Ohio, wise decision. His honesty and good sense added which later became the Medical College of the weight to his opinions. After his internship at the General in its scientific sessions and the Association Hospital, he spent considerable time abroad, always looked forward to his communications as studying at the universities of Würzburg, being of value, for they indicated the result of his Strasbourg, Berlin, and Vienna. His position this country in 1893, he began practice in Cincin- was always foremost in the advance line of nati, and, as was the custom in those days, he progress.

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Jimmy Howard voiced com- monly held reservations: I never thought about myself as a handicapped malegra fxt 140 mg without prescription. At one focus group generic malegra fxt 140mg otc, participants wondered whether their mobility prob- lems are severe enough to warrant handicapped parking permits, even though they feel they need them. They see others who are worse off, but they also find people abuse the privilege. Cynthia Walker wonders how strangers would view her: I don’t have a handicapped plate on my car. Most of the time, I don’t feel I deserve one because I see many people far worse off than myself. But once in awhile, on a flare day, when my husband’s traveling and the baby needs formula, and I just can’t maneuver the crutches and the child at the same time, I would love to have it. Once people have plates or placards, the search begins for designated parking spots. Typically, parking marked by the wheelchair logo is close to buildings, and sometimes it is extrawide to accommodate vans and wheel- chair lifts. But,“there are far more permits issued in many cities than there are reserved parking spots. Some worry that placards, in particular, are given to peo- ple with relatively minimal mobility problems. Regardless of the definition of those deserving handicapped parking spots, few disagree there are rarely enough. I think it’s very selfish of people to park in them if they aren’t authorized to do it. Walter Masterson wryly ob- served, “You compete for parking spots, and the closer into the center of Boston, the more you compete. Over the last several decades, policies relating to public transportation for people with disabilities have flipped between two notions: “effective mobility” (providing transportation by varying means, even if separate from main systems) and “full accessibility” (creating a fully integrated transportation system for everybody). Localities and companies need not retrofit existing buses with lifts, but all new buses purchased or leased must be accessible. Transportation systems obviously reflect local terrains, policies, and populations, so each is unique. Around 55 percent of people report having accessible transportation services available in their areas, but far fewer have used it in the last year: 11 percent of people reporting mild, 16 percent 124 / Outside Home—at Work and in Communities with moderate, and 17 percent with major mobility difficulties. Difficulty walking is the major impediment to using public transporta- tion, followed by needing assistance from another person and problems boarding with wheelchairs or scooters. I can do it, but older people or weaker people— there’s no way they’ll get off the bus. Similarly, elevators to underground subway stops periodically break down. Brianna therefore tries to ride her wheelchair where she needs to go—she doesn’t want to get stuck. Metropolitan Boston’s demand-responsive, public system, the RIDE, generates strong emotions. With its fleets of large, heavy vans with auto- matic wheelchair lifts, the RIDE serves people who cannot manage the fixed route systems (buses, subways) alone, or who need to go someplace the fixed route systems do not reach. Applicants for the RIDE must submit medical justifications from their physicians. For efficiency, the RIDE picks up multiple riders at the same time, so people often take numerous detours before reaching their final destinations. Not surprisingly, therefore, the major complaint about the RIDE involves delays, perceived as disrespect for people’s time, compounded by the rudeness of drivers. There have been times when I have actually had to miss a doctor’s appointment because of the RIDE. The RIDE is a horrendous company to have to use, and I have to use it every day, so I’m talking experi- ence. I always tell them that I have to be places a half hour earlier than I really do, and they still sometimes either get me there late or they don’t get me there at all. So the RIDE can be a real nightmare if you have to rely on it for medical appointments or school or work. Sometimes people have big heavy wheelchairs that take Outside Home—at Work and in Communities / 125 forever to hook up and strap down. They get me places late a lot of times, but I’m not going to yell at the driver.

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A similar buy cheap malegra fxt 140mg online, but geneti- cally distinct strain was responsible for an outbreak of HPS in logic techniques purchase malegra fxt 140mg visa. This, along with additional epidemio- difficult to demonstrate the actual virus in human tissue or to logic evidence (such as the low rodent population density in grow cultures of the virus within the laboratory, so the major- the area affected) suggest that person-to-person transmission ity of diagnostic tests use indirect means to demonstrate the was possible during this outbreak, a feature unique to any presence of the virus. Treatment of hantavirus infections is primarily support- Black Creek Canal virus has been found in Florida. It is ive, because there are no agents available to kill the viruses predominantly carried by cotton rats. About 6–15% of people who contract virus appear to be deer mice and white-footed mice. Almost half of all people who contract HPS virus has been reported in Louisiana and Texas and is carried will die. It is essential that people living in areas where the by the marsh rice rat. Oklahoma and seems to be associated with the white-footed Preventative measures focus on vector control (elimination of mouse. Monongahela virus, discovered in 2000, has been found rodents), and avoiding rodent infested areas. Hantaviruses that produce forms of hemorrhagic fever Epidemics, viral; Epidemiology, tracking diseases with renal syndrome (HFRS) cause a classic group of symp- with technology; Epidemiology; Hemorrhagic fevers and dis- toms, including fever, malfunction of the kidneys, and low eases; Virology platelet count. Because platelets are blood cells important in proper clotting, low numbers of circulating platelets can result in spontaneous bleeding, or hemorrhage. Patients with HFRS have pain in the head, abdomen, and lower back, and may report bloodshot eyes and blurry vision. Tiny pinpoint hemorrhages, called petechiae, may appear on the upper body and the soft palate in the mouth. The patient’s Hazard Analysis and Critical Control Points (HACCP) refers face, chest, abdomen, and back often appear flushed and red, as to a system that is established and instituted to monitor all if sunburned. Around day eight of HFRS, kidney involvement stages of a processing or manufacturing operation to ensure results in multiple derangements of the body chemistry. Originally, HACCP was devised for the food cause spontaneous bleeding, as demonstrated by bloody urine, processing industry. Now, HACCP has expanded to include bloody vomit, and in very serious cases, brain hemorrhages the manufacture of pharmaceuticals and other products that with resulting changes in consciousness and shock. Chain chemotherapy microorganisms antibiotics Alexander Fleming culture colony mold penicillin S. Waksman contamination bacteria fungi eye infections viruses enzyme- linked immunosorbent assay ELISA T cells B cells antibody inflammation Human Immunodeficiency Virus HIV immunodeficiency deoxyribonucleic acid ribonucleic acid immune system microorganisms Staphylococcus aureus Enterococcus faecium Streptococcus pyogenes Bacillus Calmette-Guerin WORLD OF MICROBIOLOGY AND IMMUNOLOGY IMMUNOCHEMISTRY 292 Immunoelectrophoresis Immunoelectrophoresis Immunofluorescence Isotypes and allotypes Invasiveness and intracellular infection Isotypes and allotypes smallpox pustule induced a mild case of the disease and subse- Nelmes, and inoculated James Phipps, an eight-year-old boy, quent immunity. This practice of inoculation, termed variola- who soon came down with cowpox. Six weeks later, he inoc- tion, reached England by the eighteenth century. Despite the risk, peo- tion, using the Latin word meaning cow, and ple willingly agreed to inoculation because of the widespread meaning cowpox. Within 18 who had been exposed to cowpox, a disease like smallpox months, the number of deaths from smallpox had dropped by only milder, seemed immune to the more severe infection. By continually put forth his theory that cowpox could be used to 1800, over 100,000 people had been vaccinated worldwide. The vaccine It became Jenner’s task to transform a country supersti- could then be transported. For up until the mid – Jenner was honored and respected throughout Europe 1770s, the only documented cases of vaccinations using cow- and the United States. At his request, Napoleon released sev- pox came from farmers such as Benjamin Jesty of Dorsetshire eral Englishmen who had been jailed in France in 1804, while who vaccinated his family with cowpox using a darning needle. Across the Atlantic After observing cases of cowpox and smallpox for a Ocean, Thomas Jefferson received the vaccine from Jenner quarter century, Jenner took a step that could have branded and proceeded to vaccinate his family and neighbors at him a criminal as easily as a hero.

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